Advertisement

Breast Cancer Research and Treatment

, Volume 108, Issue 1, pp 69–77 | Cite as

Symptom management after breast cancer treatment: is it influenced by patient characteristics?

  • Jean Yoon
  • Jennifer L. Malin
  • Diana M. Tisnado
  • May Lin Tao
  • John L. Adams
  • Martha J. Timmer
  • Patricia A. Ganz
  • Katherine L. Kahn
Clinical Trial

Abstract

Purpose With improved patient survival from breast cancer, more interest has evolved regarding the symptoms women experience in association with breast cancer treatments. We studied the extent to which symptoms for women with incident breast cancer are addressed by their physicians and how symptom management varies with patient characteristics. Methods As part of the Los Angeles Women’s (LAW) Study, we categorized women from a population-based study of incident breast cancer (n = 1,219) as having an unmet need if she had at least one severe symptom (any of the following: nausea/vomiting, arm problems, hot flashes, vaginal dryness, difficulty sleeping) for which she did not receive the help she wanted. Multivariable analyses predicted having any unmet need as a function of patient demographic and health characteristics. Results The prevalence of unmet need varied by the type of symptom with the highest proportion of women receiving help for nausea and vomiting (0.91) and the lowest for vaginal dryness (0.48). Black women (OR = 3.61, 95% CI: [1.57, 8.31]), and Spanish-speaking Hispanic women (OR = 2.69, 95% CI: [1.22, 5.94]) were significantly more likely than white women to report an unmet need. More black and Hispanic women compared to white women cited the doctor not thinking treatment would benefit her (P = 0.02), not appreciating how much the problem bothered her (P = 0.03), not knowing about treatments (P < 0.0001), or insurance/cost barriers (P = 0.009) as reasons for her unmet need. Conclusion These results show the persistence of racial disparities in the receipt of appropriate care within the health care system.

Keywords

Breast cancer Disparities Quality of care Symptom management 

Notes

Acknowledgments

We would like to acknowledge Dennis Deapen, MD, Donna Morell, and Ann Hamilton for assistance in using the Los Angeles County SEER Rapid Case Ascertainment (RCA) program. Financial support: National Cancer Institute Grant # R01 CA 81338-01A1. Dr. Ganz was also supported by an American Cancer Society Clinical Research Professorship award. Dr. Malin was supported by a CI-10 Damon Runyon-Lilly Clinical Investigator Award from the Damon Runyon Cancer Research Foundation.

References

  1. 1.
    Ganz PA (1992) Treatment options for breast cancer – beyond survival. N Engl J Med 326(17):1147–1149PubMedCrossRefGoogle Scholar
  2. 2.
    Rao RS, Graubard BI, Breen N et al (2004) Understanding the factors underlying disparities in cancer screening rates using the Peters-Belson approach: results from the 1998 National Health Interview Survey. Med Care 42:789–800PubMedCrossRefGoogle Scholar
  3. 3.
    Hunter CP, Redmond CK, Chen VW et al (1993) Breast cancer: factors associated with stage at diagnosis in black and white women. J Natl Cancer Inst 85:1129–1137PubMedCrossRefGoogle Scholar
  4. 4.
    Li CI, Malone KE, Daling JR (2003) Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med 163:49–56PubMedCrossRefGoogle Scholar
  5. 5.
    Ballard-Barbash R, Potosky AL, Harlan LC et al (1996) Factors associated with surgical and radiation therapy for early stage breast cancer in older women. J Natl Cancer Inst 89:716–726CrossRefGoogle Scholar
  6. 6.
    Silliman RA, Guadagnoli E, Weitberg AB et al (1989) Age as a predictor of diagnostic and initial treatment intensity in newly diagnosed breast cancer patients. J Gerontol 44:M46–M50PubMedGoogle Scholar
  7. 7.
    Ayanian JZ, Guadagnoli E (1996) Variations in breast cancer treatment by patient and provider characteristics. Breast Cancer Res Treat 40:65–74PubMedCrossRefGoogle Scholar
  8. 8.
    Bickell NA, Wang JJ, Oluwole S et al (2006) Missed opportunities: racial disparities in adjuvant breast cancer treatment. J Clin Oncol 24(9):1357–1362PubMedCrossRefGoogle Scholar
  9. 9.
    Anderson KO, Mendoza TR, Valero V et al (2000) Minority cancer patients and their providers: pain management attitudes and practice. Cancer 88:1929–1938PubMedCrossRefGoogle Scholar
  10. 10.
    Cleeland CS, Gonin R, Hatfield AK et al (1994) Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 330:592–596PubMedCrossRefGoogle Scholar
  11. 11.
    Cleeland CS, Gonin R, Baez I et al (1997) Pain and treatment of pain in minority patients with cancer. Ann Intern Med 127:806–813Google Scholar
  12. 12.
    Stanton AL, Bernaards CA, Ganz PA (2005) The BCPT symptom scales: a measure of physical symptoms for women diagnosed with or at risk for breast cancer. J Natl Cancer Inst 97(6):448–456PubMedCrossRefGoogle Scholar
  13. 13.
    Oncology Nursing Society. Outcomes Resource Area (2006) Available at: http://www.ons.org/outcomes/ index.shtml. 2006Google Scholar
  14. 14.
    Ware JE, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233PubMedCrossRefGoogle Scholar
  15. 15.
    Kahn KL, MacLean CH, Liu H, et al (2006) The application of explicit process of care measurements to rheumatoid arthritis: moving from evidence to practice. Arthritis Rheum 55(6): 884–891PubMedCrossRefGoogle Scholar
  16. 16.
    Heckman JJ (1979) Sample selection bias as a specification error. Econometrica 47:153–161CrossRefGoogle Scholar
  17. 17.
    White H (1980) A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica 48:817–830CrossRefGoogle Scholar
  18. 18.
    Ganz PA, Rowland JH, Desmond K et al (1998) Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol 16(2):501–514PubMedGoogle Scholar
  19. 19.
    Ganz PA, Desmond KA, Belin TR et al (1999) Predictors of sexual health in women after a breast cancer diagnosis. J Clin Oncol 17(8):2371–2380PubMedGoogle Scholar
  20. 20.
    Ganz PA, Greendale GA, Petersen L et al (2000) Managing menopausal symptoms in breast cancer survivors: results of a randomized controlled trial. J Natl Cancer Inst 92(13):1054–1064PubMedCrossRefGoogle Scholar
  21. 21.
    Smedley BD, Stith AY, Nelson AR (eds) (2002) Unequal treatment: confronting racial and ethnic disparities in health care. Institute of Medicine, National Academy Press, Washington DCGoogle Scholar
  22. 22.
    Gordon HS, Street RL Jr, Kelly PA et al (2005) Physician-patient communication following invasive procedures: an analysis of post-angiogram consultations. Soc Sci Med 61(5):1015–1025PubMedCrossRefGoogle Scholar
  23. 23.
    Liang W, Burnett CB, Rowland JH et al (2002) Communication between physicians and older women with localized breast cancer: implications for treatment and patient satisfaction. J Clin Oncol 20(4):1008–1016PubMedCrossRefGoogle Scholar
  24. 24.
    Cooper LA, Roter DL, Johnson RL et al (2003) Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med 139(11):907–915PubMedGoogle Scholar
  25. 25.
    Cooper-Patrick L, Gallo JJ, Gonzales JJ et al (1999) Race, gender, and partnership in the patient-physician relationship. JAMA 282(6):583–589PubMedCrossRefGoogle Scholar
  26. 26.
    Ayanian JZ, Zaslavsky AM, Guadagnoli E et al (2005) Patient perceptions of quality of care for colorectal cancer by race, ethnicity, and language. J Clin Oncol 23(27):1–11CrossRefGoogle Scholar
  27. 27.
    LaVeist TA, Nickerson KJ, Bowie JV (2000) Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev 57(Suppl 1):146–161PubMedCrossRefGoogle Scholar
  28. 28.
    Cooper-Patrick L, Gallo JJ, Gonzales JJ et al (1999) Race, gender, and partnership in the patient-physician relationship. JAMA 282(6):583–589PubMedCrossRefGoogle Scholar
  29. 29.
    Smedley BD, Stith AY, Nelson AR (eds) (2003) Committee on understanding and eliminating racial and ethnic disparities in health care. Unequal treatment: confronting racial and ethnic disparities in health care. National Academy Press, Washington D.CGoogle Scholar
  30. 30.
    Keating NL, Gandhi TK, Orav EJ et al (2004) Patient characteristics and experiences associated with trust in specialist physicians. Arch Intern Med 164(9):1015–1020PubMedCrossRefGoogle Scholar
  31. 31.
    Trivedi AN, Zaslavsky AM, Schneider EC et al (2005) Trends in the quality of care and racial disparities in Medicare managed care. N Engl J Med 353(7):692–700PubMedCrossRefGoogle Scholar
  32. 32.
    Jha AK, Fisher ES, Li Z et al (2005) Racial trends in the use of major procedures among the elderly. N Engl J Med 353(7):683–691PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Jean Yoon
    • 1
  • Jennifer L. Malin
    • 2
  • Diana M. Tisnado
    • 3
  • May Lin Tao
    • 4
  • John L. Adams
    • 5
  • Martha J. Timmer
    • 5
  • Patricia A. Ganz
    • 6
    • 7
  • Katherine L. Kahn
    • 3
    • 5
  1. 1.School of Public Health, Health Services DepartmentUniversity of California at Los AngelesLos AngelesUSA
  2. 2.AmgenThousand OaksUSA
  3. 3.Division of General Internal Medicine and Health Services Research, School of MedicineUniversity of California at Los AngelesLos AngelesUSA
  4. 4.Valley Radiotherapy Associates Medical GroupEl SegundoUSA
  5. 5.RANDSanta MonicaUSA
  6. 6.School of Public Health and School of MedicineUniversity of California at Los AngelesLos AngelesUSA
  7. 7.Jonsson Comprehensive Cancer Center at UCLALos AngelesUSA

Personalised recommendations